JERRY LEE ELLWANGER

NEWARK, CA
NPI1982845905
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2009-03-20
Last Update Date2009-03-20
Business Address
-- JERRY LEE ELLWANGER
6330 THORNTON AVE
NEWARK, CA 94560-3734
Phone number: 510-792-4357
Mailing Address
-- JERRY LEE ELLWANGER
6330 THORNTON AVE
NEWARK, CA 94560-3734
Phone number:
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